Federal government may deny blind people access to low-vision devices.

MuskogeePhoenix.com, Oklahoma.
Sunday, May 28, 2006.

The federal government may deny some blind people access to low-vision devices. But, the apparent savings to the Medicare program may reappear as other medical costs.

The Center for Medicare and Medicaid Services (CMS) announced its intention to bar coverage of low-vision devices, including closed-circuit television systems (CCTVs), magnifiers and other technology that helps people with vision loss live independent lives. The American Foundation for the Blind (AFB) and others are working to ensure the proposal doesn't take effect.

The number of Americans with eye diseases is increasing, and vision loss is expected to become a major public health problem as baby boomers age, according to the AFB. More than 6.5 million Americans 55 and older are blind or severely visually impaired. The number is expected to double by the year 2030.

Wayne Wallace, 56, an instructor at the Talking Leaves Job Corps Center in Tahlequah, said diabetes limited his effectiveness until he got low-vision technology that magnifies his computer screen.

"I need to grade papers and help students with writing essays and doing math," he said. "Being able to see is important. If I hadn't been able to do that, my teaching career would have been cut short."

Wallace teaches career preparation to students ages 16 to 24. He was having more and more trouble reading the screen on his computer before he got the image magnifier.

"I set it to increase my screen size two times," he said. "That made my day 100 percent better."

The Social Security Act contains the language the CMS uses as a guide for Medicare reimbursement. It contains a section saying certain eyeglasses are excluded from reimbursement. The language of that section has often been extended to apply to low-vision aids, and many reimbursements were only possible after legal action.

The CMS published a statement in the Federal Register on May 1, proposing to revise the Act "... to expressly state that the eyeglass exclusion applies to all devices that use one or more lens for the primary purpose of aiding vision."

The CMS said they have expressed their view in the past and now intend to make it strict policy.

"From as early as 1980, we have clarified that we viewed closed circuit visual aid systems and other low-vision devices to be subject to the eyeglass coverage exclusion ...," they said. "However, we have never issued a regulation or national coverage decision ..."

At the Oklahoma School for the Blind, Superintendent Karen Kizzia said low-vision aids help disabled people be productive members of society.

"Assistive technology devices allow people to remain independent," she said. "What the government is proposing is limiting people's ability to live independently. Someone will have to pick up the tab somewhere along the line."

Kizzia said a lot of hard work has gone into the development of low-vision aids, and Medicare has been an important way to make sure they were available to people with limited income.

"It sends a message that if you develop innovative technology, the only people who will benefit will be the wealthy," she said.

Preventing citizens from being active is not what this nation stands for, Kizzia said, and most people want to see their taxes used wisely.

"Doors were open (to the disabled) in the past," she said. "Now it looks like slamming the doors in their faces. I think the average taxpayer would rather give money to have a wonderful impact on someone's ability to be a taxpayer."

The CMS proposal also set off alarm bells at the Oklahoma Department of Rehabilitation Services (DRS).

Jean Jones, public information officer for the DRS, said her department does not agree with the federal government's language about low-vision aids.

"We see this as something medical that people need and not eyeglasses by any stretch of the imagination," she said.

The AFB said in a media release that the exclusion would hurt senior citizens.

"Barring coverage of low-vision devices would have devastating effects on the quality of life of aging Americans and others with vision loss," said Carl R. Augusto, AFB's president and CEO. "These tools are the very key to remaining active and living independently and safely with eye conditions such as age-related macular degeneration, glaucoma, cataracts and diabetic retinopathy."

Dr. George Foster, dean of the School of Optometry at Northeastern State University, predicts the attempt to cut corners will only create new medical costs and cause suffering.

"The whole purpose of low-vision aids is that they can remain independent," he said. "The technology allows them more flexibility in their lifestyle, and they will not become dependent on their family or an institution. Otherwise they are likely to experience depression, which will result in increased costs for medicine and treatment. We'll end up spending more."